SHLDR/AC/SC PROC. Flashcards by Jolene Lavelle

LABEL THE IMAGE

A. Superior scapular angle
B. Clavicle
C. Acromion process
D. Humeral head
E. Greater tubercle
F. Glenoid cavity
G. Lateral border of the scapula
H. Coracoid Process

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LABEL THE IMAGE

A. Superior scapular angle
B. Acromion process
C. Glenoid cavity
D. Scapular body
E. Clavicle
F. Coracoid process
G. Lesser tubercle

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LABEL THE IMAGE

A. Acromion
B. Acromial end/extremity
C. Coracoid process
D. Superior scapular angle
E. Vertebral border of scapula
F. Sternal end/extremity
G. Vertebral column

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LABEL THE IMAGE

A. Acromion
B. Acromial end/extremity
C. Sternal End/Extremity
D. Superior scapular angle
E. Medial clavicle

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LABEL THE IMAGE

A. Acromion
B. Clavicle
C. Coracoid process
D. Scapular spine
E. Superior angle
F. Vertebral border
G. Inferior angle
H. Lateral border
I. Neck
J. Glenoid cavity

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LABEL THE IMAGE

A. Head of humerus
B. Greater tubercle
C. Intertubercular groove/sulcus
D. Lesser tubercle
E. Anatomic neck
F. Surgical neck
G. Body of humerus

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What type of bone is the clavicle?

Long bone

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Lateral end of clavicle:
Articulates with:
Medial end of clavicle:
Articulates with:

lateral or acromial extremity - art. acromion process
medial or sternal extremity -art. manubrium of sternum & the first costal cartilage.

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Joints of shoulder girdle are classified as:
Movement:
Names of joints:

synovial joints
freely movable or diarthrotic.
Scapulohumeral joint – ball and socket
Acromioclavicular (AC) joint – gliding (or plane)
Sternoclavicular (SC) joint – gliding (or plane)

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Which joint is only joint that connects shoulder girdle and thorax

SC Joint

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AP CLAVICLE
TECHNIQUE:
CR:
RESPIRATION: (& WHY)
ANATOMY:

TECHNIQUE: 70 - 75 kV @ 8 - 12 mAs
CR: PERP. TO MIDCLAVICLE
RESPIRATION: SUSPEND @ END OF INSPIRATION (ELEVATES CLAV)
ANATOMY: Entire clavicle, both AC and SC joints
- Midclavicle is superimposed on the superior scapular angle

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AP AXIAL - CLAVICLE
TECHNIQUE:
CR:
ANGLE: (WHY)
RESPIRATION: (& WHY)
ANATOMY:

TECHNIQUE: 70-75 KV @ 8-12 MAS
CR: MID CLAVICLE
ANGLE: 15-30* CEPHALIC (DEGREE OF FX DISPLACEMENT)
RESPIRATION: SUSPEND AT END OF INSPIRATION (ELEVATES CLAV)
ANATOMY: Clavicle is above scapula and the ribs
-Medial end of clavicle is superimposed over 1ST/2ND ribs

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LABEL THE IMAGE

A. SC joint
B. Sternal extremity of clavicle
C. Body of clavicle
D. Acromial extremity of clavicle
E. AC joint
F. Scapulohumeral joint

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AP AC JOINT
AKA:
ROUTINE:
TECHNIQUE:
SID:
WHY PREFORMED:
IR:

AKA: PEARSON METHOD
ROUTINE: AP BILAT W/O WEIGHTS & AP BILAT W/ WEIGHTS
TECHNIQUE: 75-85 KV @ 16-24
SID: 72 SID
WHY PREFORMED: POSS. AC JOINT SEPERATION
IR: LANDSCAPE / TOP OF IR 2 IN ABOVE SHOULDER

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WHAT IS PEARSON METHOD?
WHAT IS DONE PRIOR TO PEASRON METHOD & WHY?
WHAT IS INDICATED IF THERE IS A WIDENING JOINT SPACE?

PEARSON = AP AC JOINTS W & W/O WEIGHTS
- CLAVICLE OR SHOULDER XRAY FIRST R/O FX
- WIDENING JOINT SPACE = SEPERATION OF AC JOINTS

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AP AC JOINTS
AKA:
CR:
RESPIRATION:
HOW PREFORMED?
ANATOMY:

AKA: PEARSON METHOD
CR: PERP, BTWN AC JOINTS (1IN ABOVE JUG. NOTCH)
RESPIRATION: SUSPENDED
PREFORMED: 2 EXPOSURES, 1 W. WEIGHT, 1 W/O WEIGHT. STRESS VIEW W. WEIGHT AROUND WRIST
ANATOMY: Both AC joints, entire clavicles, & SC joints
- AC joints on the same horizontal plane.
-No rotation, Symmetric appearance of SC joints

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IF UNILATERAL PEARSON - WHAT IS CR?
WHERE ARE WEIGHTS? WHY?

CR: 1IN BELOW AC JOINT OF AFFECTED SIDE
8-10 LBS AROUND WRIST: HOLDING WEIGHTS MAKE SHOULDERS CONTRACT

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WHAT PROJECTION?

LEFT IMAGE = PEARSON W/0 WEIGHT
RIGHT IMAGE = PEARSON W. WEIGHTS

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PA SC JOINTS
TECHNIQUE:
CR:
RESPIRATION:
ANATOMY:

TECHNIQUE: 75-85 @ 10-12
CR: PERP TO MSP @ T2-T3 (APROX. 3IN DISTAL TO C7)
RESPIRATION: SUSPEND ON EXPIRATION
ANATOMY: BILAT SC JOINS, MEDIAL CLAVICLES THROUGH RIBS & LUNGS

ANTERIOR OBLIQUE POSITIONS SC JOINTS
______ & ________
POSITIONS:
CR:
RESPIRATION:
ANATOMY:

RAO (RIGHT) & LAO (LEFT)
POSITIONS: 10-15* ROTATION
CR: PERP TO T2-T3 (3IN DISTAL TO C7), 1-2IN LATERAL MSP (TOWARD UPSIDE)
RESPIRATION: SUSPEND EXPIRATION
ANATOMY: Sternoclavicular joint on the downside seen
- Manubrium & medial clavicle on downside
- SC joint on upside is foreshortended

HOW DOES CR ENTER ON PA OBLIQUE SC JOINTS?
WHAT ANGLE MAY BE USED ON PA OBLIQUE SCJ?

CR ENTERS UPSIDE, AND VISUALIZES DOWNSIDE
CR: 15* ACROSS PATIENT (UNAFFECTED SIDE TOWARD AFFECTED SIDE)

TWO SURFACES OF SCAPULA:
THREE BORDERS:
THREE ANGLES:
THICKEST PART OF SCAP BODY:

Costal (anterior) and Dorsal (posterior)
Lateral (axillary), Medial (vertebral), Superior
Superior, Inferior, Lateral
LATERAL ANGLE

WHAT IS CORACOID PROCESS? WHERE LOCATED?
WHERE IS SCAPUHUMERAL JOINT? TYPE OF JOUNT? OTHER NAMES:

Coracoid process = beaklike process projects anteriorly beneath the clavicle. (located on scapula)
BETWEEN GLENOID CAVITY & HEAD OF HUMERUS
- SYNOVIAL, BALL&SOCKET
- AKA: GLENOHUMERAL OR SHOULDER JOINT

SHOULDER GIRDLE CONSISTS OF:

PROXIMAL HUMERUS HAS _____ ANTERIORLY & ______LATERALLY, WITH ________ IN BETWEEN.

ACROMION OVERHANGS SHOULDER ________-

CLAVICLE & SCAPULA
LESSER TUBERICLE ANT, GREATER TUBERICAL LATERALLY & INTERTUBERCLE GROOVE BTWN
-POSTERIORLY

ROUTINE PROJECTIONS OF SHOULDER: ADVANCED: TECHNIQUES: SID:

R: AP EXTERNAL, INTERNAL & PA OBLIQUE (SCAP Y) - NUETRAL (IF TRAUMA) A: LAWRENCE, GRASHEY & NEER METHODS - 70-75 @ 10-16 MA / SCAP Y: 70-75 @ 20-25 SID: 40 IN

WHICH POSITION IS THE ARM IN THESE XRAYS:

FIRST = EXTERNAL ROTATION SECOND = INTERNAL ROTATION THIRD = NEUTRAL

AP SHOULDER - EXTERNAL ROTATION CR: ANATOMY: EPICONDYLES:

CR: PERP. TO 1 IN INFERIOR TO CORACOID PROCESS EPICONDYLES: PARALLEL WITH IR ANATOMY: Greater tubercle in full profile laterally. - Lesser tubercle superimposed over humeral HEADD -Humeral head in profile medially.

AP SHOULDER - INTERNAL ROTATION CR: ANATOMY: EPICONDYLES:

CR: PERP. TO 1 IN INFERIOR TO CORACOID PROCESS EPICONDYLES: PERP. TO IR ANATOMY: LESSER TUBERCLE IN FULL PROFILE MEDIALLY - GREATER TUBERCLE ANTERIOR, SUPERIMP NY HUMERAL HEAD - LATERAL VIEW OF PROX HUMERUS

AP SHOULDER - NEUTRAL CR: ANATOMY: EPICONDYLES:

PERP. TO 1 IN INFERIOR TO CORACOID PROCESS EPICONDYLES: 45* ANGLE WITH IR ANATOMY: GREATER TUBERCLE IS PARITALLY IN PROFILE LATERALLY, LESSER TUBERCLE ANTERIORLY

IDENTIFY A & B

A. GREATER TUBERCLE B. LESSER TUBERCLE

PA OBLIQUE SHOULDER AKA: POSITION: CR: ANATOMY:

SCAPULAR Y PATIENT 45-60* FROM MCP TO IR CR: PERP. TO SCAPULOHUMERAL JOINT ANATOMY: ACROMION & CORACOID PROCESS FORM "Y" ARMS & SCAP BODY FORMS LEG OF "Y"

HOW TO IDENTIFY SHOULDER DISLOCATION

- Anterior dislocation- humeral head sits anteriorly, below the coracoid process. - Posterior dislocation- humeral head is seen posteriorly, below the acromion. - *No dislocation or injury:* Humeral head and glenoid cavity, and the scapular body and humeral shaft are superimposed - Humeral head is superimposed over the junction of the “Y”

Pathology in Images

LEFT IMAGE - Posterior Dislocation (humoral head away from body) RIGHT IMAGE - Anterior Dislocation (numeral head over body)

INFEROSUPERIOR AXIAL PROJECTION AKA CR POSITION RESPIRATION ANATOMY

AKA- LAWRENCE METHOD CR - medially 25-30* horizontal to axilla & humeral head POSITION - Arm abducted 90* from body, humerus in external position -Shoulder elevated 2 in RESPIRATION - suspend ANATOMY - Open glenohumeral joint space - Glenoid cavity in profile - Coracoid process in profile - Lesser tubercle of humerus in profile - Acromioclavicular joint

In the Lawrence method, the greater the arm abduction = What do you do if arm is less than 90* abduction in lawrence method? Is Lawrence method trauma? Alternative

- greater arm abd = greater CR angle - less than 90* = CR 15-20* (decrease) - Lawrence is nontrauma

Lawrence Method, Alternative position = _____________________ Demonstrates: What is clements modification? Why done?

- exaggerated external rotation (thumb pointed down & post. 45*) - Demon. Hill-Sach Defect -Clements is alternative to Lawrence position. Arm straight up, CR perp to IR (if cant abduct - CR 5-15* perp to axilla)

What is Hills-Sach defect? What projection demonstrates this? Which scapular structures is most posterior? A. Coracoid process. B. Glenoid cavity C. Scapular notch. D. Acromion

- Compression fx of humeral head - Shown on exaggerated external rotation (lawrence method) - Acromion

LABEL THE IMAGE What projection is this?

A. Lesser tubercle B. Surgical neck C. Acromion D. Spine of scapula E. Coracoid process F. Head of humerus G. Glenoid fossa - Lawrence Method

AP oblique projection – GLENOID CAVITY AKA: CR: POSITION: RESPIRATION: ANATOMY:

AKA: Grashey CR: Perp. to IR @scapulohumeral joint. POSITION: 35-45* rotation toward affected side (scap. parallel) RESPIRATION: Suspended ANATOMY: The scapulohumeral joint is open - Glenoid cavity in profile w/o superimposition of humeral head

Tangential SUPRASPINATUS OUTLET AKA: CR: ANGLE: POSITION: RESPIRATION: ANATOMY:

AKA: NEEE METHOD CR: 10-15* caudad @ superior margin of humeral head POSITION: PA (or face board) 45-60* rotated from MCP, affected side to IR RESPIRATION: ANATOMY: Coracoacromial arch for supraspinatus outlet region for possible shoulder impingement. - Supraspinatus outlet region open, free of superimp. by humeral head - scapula in lateral profile, “Y” view

Which AP prox. shoulder projections will demonstrate the lesser tubercle in profile medially? A. External B. Neutral C. Internal Which demonstrates coracoacromial arch? a. Scapular Y b. Lawrence c. Neer d. Grashey How much is the body rotation for a posterior oblique position (Grashey method)?

- Internal - NEER -35-45*

For an inferosuperior axial shoulder projection, 1. The patient’s shoulder is elevated on a sponge or washcloth. 2. The patient’s head is tilted and rotated toward the affected shoulder. 3. The patient’s affected arm is externally rotated. 4. 25 to 30 degree central ray to lateral body surface angle is used if the arm is abducted at a 90-degree angle to the torso.

1. 3 & 4

For an AP oblique shoulder projection (Grashey method), the 1. patient’s midcoronal plane is rotated to a 45-degree angle with the IR. 2. central ray is centered to the scapulohumeral joint. 3. patient is rotated toward the affected shoulder. 4. image is obtained with the patient in an upright or supine position.

1, 2, 3 & 4

A referring physician suspects that a subacromial spur may be the cause for a patient’s shoulder impingement. She asks the technologist for a projection that would best demonstrate any possible spurs in the supraspinatus outlet. Which of the following projections would accomplish this objective? a. Tangential projection with 10° to 15° caudad angle b. Tangential projection with 10° to 15° cephalad angle c. AP oblique shoulder with 45° caudad angle d. AP shoulder with 10° to 15° caudad angle

A. Tangential projection with 10° to 15° caudad angle

Which of the following are clearly demonstrated on the inferosuperior axial projection of the shoulder joint? Proximal humerus Scapulohumeral joint Acromioclavicular articulation

1, 2 & 3 (ALL)

The PA oblique projection of the shoulder joint (scapular Y) is performed in which of the following positions? a. AP. b. Lateral c. RAO or LAO d. RPO or LPO

RAO & LAO

The glenohumeral joint space is demonstrated as an open space on a(n): - Inferosuperior axial shoulder. - Transthoracic lateral shoulder. - AP oblique shoulder (Grashey). - PA oblique scapular Y shoulder

Inferosuperior axial shoulder & AP oblique shoulder (Grashey).